Individual
MICHAEL CHARLES LICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4300 MARKET PTE DR STE 100, BLOOMINGTON, MN 55435-5435
(457) 495-2767
Mailing address
115 W 5TH ST # 2, DULUTH, MN 55806-2729
(612) 708-8024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/19/2023
Last updated
01/13/2025
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